We are placing midline catheters for vancomycin infusion in the hospital setting, outpatient use, and in patients that get transferred to skilled nursing facilities for infusion. Certain of the physicians fight us on this, despite presentation of our evidence (INS standards, evidence-based theory, experience) that a PICC is preferable. We are uncertain the dwell time of the midlines in patients who leave the hospital with these lines in place, probably upwards of a month. One physician routinely orders midline catheters for 2 weeks duration of vancomycin. Our hospital policy follows INS standards and states midlines should not be used for pH <5 or pH >9. We brought our dilemma to the attention of the hospital administration, showed our evidence, and they chose to support the physician wishes on the use of midline catheters for vancomycin. We are to continue placing midlines for vancomycin infusion. They are removing the "pH" information in the policy for midline use. Are we still liable if damages occur to the patient? Should we inform the patient of increased risk of vancomycin when we obtain consent for line placement? Any advice?
When I first read your message, my impression was not what I thought when I read it again. I think you are saying that your team is expected to place midlines for vancomycin and this action is against your professional judgement. Physicians and administration are forcing you to place midlines for what you consider to be incorrect therapies. Is this assessment correct? If so, what I am about to tell you will be harsh and it will probably indicate that you should start looking for another job!
I am not sure what research and other evidence you have used to suppport your position. But it sounds like administration has chosen to support the physicians in opposition to your concerns for best practice. I would just say NO, I will not do that!! Firmly, nicely, without anger but with a professional attitude that this is dangerous for patients and you will no longer accept the accountability for this practice. Be prepared to remain firm in your position. Take this to risk manageent if your have not already done so. Take it to your union if you work in a union hospital. Take this to your state board of nursing for their opinion. Be prepared to get fired as it very well could come down to this.
You asked about your liabilitiy. You can take it to the bank that you and your team members who are doing this will bear all accountability for the outcome of this decision. I can easily see a lawsuit with this hypothetical situation - vein thrombosis occuring in one of those patients transferred to a nursing home. The nursing home nurses do not have the knowledge to assess the vein condition and may easily overlook the signs and symptoms. This thrombosis is so bad that it produces excessive amounts of edema that causes nerve damage and the patient develops complex regional pain syndrome, a long term chronic condition requiring narcotics for pain management the rest of the patient's life. Or the outcome could be death from sepsis originating from this thrombosis. These are just two possible outcomes. In the lawsuit, the physicians will not support you. The minutes from all of your meetings with administration will not be released to the attorneys. The lawsuit will be brought against the hospital, the nursing home and the nurse inserting the midline. Depositions will be taken. Patient medical records, policies and procedures will be thoroughly examined by nurse experts. The INS standards of practice, along with several published articles that I can readily think of now will be used to support the opinion of the nurse experts. Drug literature will be used. This will come down to a settlement immediately prior to the jury trial if the patient or their family is willing to accept the offer made by the defense attorney. Or it could go all the way to a jury trial. Then it is totally and completely in the hands of the jury and which sides experts are the most believable. So to protect yourself, I would move on to another job. If you are certain that there is absolutely nothing else that you can do to change the decision by administration, you are no longer in a position to protect your patients. The only thing you can do is to leave. Sad, but I beleive this to be true. You are still liable for the outcome of what you do. If you perform below the standard of care, then you will be liable. The standard of care is what another reasonable and prudent nurse would do in the same or similar situation. As one of those experts, I would say that placing a midline in such as patient to receive vancomycin is not what other reasonable and prudent nurses would do. You are allowing the physicians and your employer to "force" you to practice below the standard of care, but you will be still held accountable. Regarding informing patients, this should already be a part of the informed consent that your patients are signing now. If this is not included, then this is another reason to give up on this employer! Sorry to paint such a drastic picture, but I strongly believe your are no longer in a position to make changes according to what you stated. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
One other thing - those possible scenarios I mentioned have happened in many cases with short peripheral IV catheters and I have served as one of the experts in those cases. Vein thrombosis has produced CRPS in several cases. I have had a case of death from sepsis due to a short peripheral catheter. I have no knowledge of simiar events happening with a midline catheter but I strongly believe it is probable that this will happen eventually in situations such as what you described. I do have a series of photos of vein thrombosis from a midline that was used for inappropriate therapies and the required surgery, however this did not result in a lawsuit and I do not have complete information about what was actually infused through the midline. I think we have not seen this with midlines yet because of evidence-based practice and the standards of practice. If more nurses find themselves in your situation, I would predict that we will be seeing such cases with mdilines. Also, in such a legal case, the plaintiff only has to show evidence and an expert opinion that what happened was more probable than not or the chance was 51%. The plaintiff does not have to prove beyond a reasonable doubt as that only applies to criminal cases. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
You understood correctly, Lynn and I deeply appreciate your response. We presented the administration with a lot of evidence including several vancomycin infiltration research articles, drug literature which recommends rotating IV sites to avoid thrombophlebitis (midline sites are not rotated of course). We contacted our board of nursing. Their response was that they did not know what a midline catheter was, but that assuming it was something like a PICC, we must follow nursing standards and hospital policies. We presented their response to the administration also. We also discussed that since our hospital is a Magnet hospital, whose focus is supposed to be nursing excellence, we should meet and exceed nursing standards. We really feel like it was presented to the administration well.
We have not talked to risk management but will do so next. We do not have a union to help us. In fact, our own supervisor, who wrote the midline placement policy (stating only for medications with pH 5-6) made the agreement with the physician to place midline catheters for vancomycin infusions of 2 weeks duration. I imagine we will get fired. There are almost no nursing jobs in our area presently. This is just a terrible situation.
If this hospital is giving you two choices to choose from: Either to do something to harm the patient or to lose your job, why don't you sue this hospital for not allowing you practice nursing in the right way.
Just a thought -- since the hospital has magnet status, can the conferring authority for " magnet" or Joint Commission be an advocate to support you? Did the hosp administration offer any supporting documentation for their position? (HAHA)
Are they aware juries are very supportive to plaintiffs who have sustained a most likely preventable injury. BIG AWARDS !
Hitting the hosptial with info on what it can cost them in a law suit (for being stubbron)
McGarry vs. Memorial Hospital (Ormand Beach, FL) 2005). 7.5 Million Dollars.
Lynn's remarks re law suit are right on.
Ann
Ann Zonderman, BSN, JD, CRNI
Midlines and Vanco don't go together, buck up, be a resolute patient advocate and refuse to place them.
I have an interesting perspective because I have trained a team that is in this exact situation. It may even be your team!
To answer the legal question yes you are liable. I also believe if an untoward event were to occur, gross negligence and malpractice on the facilities part could easily be demonstrated to a jury because your facility is eliminating language in a policy which protects patients, and is doing so to presumably "keep you quiet". Additionally if you are the facility I trained your team and your supervisor were specifically advised not to use midlines for Vanco. Whistleblower laws were written to protect people in your situation. Do the right thing and stop placing these lines, get a labor law attorney to protect your jobs, you will prevail because you are doing the right thing.
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness
Assuming I am correct in my previous post and I did train your team I thought I would provide a plan of action. If I have the wrong account you may still find this useful. 1. You are in Northern Virginia so you should have no problem finding a labor law attorney. Find one and get an initial consult. These are often free but you should offer to pay a fee for the consult. Make sure you bring a written history of what has transcribed so far, put it in a timeline form that is easy to read and leave the emotion out. Bring your clinical references and INS standards. Find out if you are protected under the whistleblower laws. 2. Find out who the local news reporter is that is a "on your side" type of reporter. Almost all local news channels have a consumer protection specialist reporter. Get his or her name and contact information but do not contact them yet. 3. Arrange a meeting with your CEO. Do not go through the normal chain of command as that has not resolved anything to date. Set this meeting up in person at his/her office, not on the phone. State this will be a brief 10 min. meeting concerning grave concerns over patient safety. Do not give a lot of details while setting up the meeting. If you are denied the meeting or if you get the meeting with no action taken, inform the CEO that you are contacting the local reporter about the unsafe practice and also inform them you have obtained legal counsel to protect your rights. Be respectful, determined and factual. That should hopefully get the ball rolling in the right direction. "Obstacles will appear large or small to you according to whether you are large or small" Owen Swett Marden
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness
If the issue with management is fee for placement, the fee to insert a midline is the same as the fee for inseriton of a PICC. If you're doing CXRs for tip placement confirmation that would be the only additional cost. Operational cost for the CXR is minimal and certainly pales in the face of negative publicity (newspaper or TV news coverage) or legal defense. I think your team should flat-out refuse to place a ML in these circumstances. If you stand shoulder to shoulder on this it would help.
We currently have a very narrow listing of rationale for ML placement. I also have pictures of negative outcomes.....
Alma Kooistra CRNI
I am wondering if there issue is one I am hearing more of these days. Does your state require public reporting of CLABSI? If so, an infection from a PIV or midline is not reported, so reducing the number of central lines used reduces the possibility of CLABSI and thus the number that must be made public. CLABSI reporting is done through a voluntary system at CDC. They have a very strict definition of a central line and this is only for bloodstream infections. The CDC system does not allow for other catheters or other types of infection. This system is the one most commonly used for collecting data in a consistent manner and for public reporting of infection rates. I have heard through many sources that administrators are trying to force the number of central lines down to reduce these numbers. They are not thinking about the other negative outcomes when inappropriate medications are infused through a PIV or midline and the serious ramifications to the patient from these complications. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I still see this all the time. Many times MDs who manage patients in long term care are worried that PICC lines will cause more problems then they are worth. They fear DVTs, poor care by the staff nurses who are managing the patients, complications when the PICC is removed either by the staff or the patient, problems with the PICC becoming occluded and other complications due to improper care and maintenance. They do not feel they have to follow or believe in the INS standards of practice, and discount that reference. The problem arises when one RN refuses to place the Midline, and another folllows behind and does it. It just makes the first RN look like a "difficult nurse"
Stand together and fight for what is best for the patient. Publish your story as an example to others. Good luck
Chris Cavanaugh, RN, BSN, CRNI, VA-BC
Sumrsun,
Tell your physicians this.....Vanco ph 2.9......Vinegar ph 2.4-3.4......would they want vinegar running through their veins?....I think not.
Their answer will always be (and you simply have to love this) you can give it through a peripheral. Love that one. Your problem is not unique. I suggest if they order a Midline for Vanco simple have them write an order OK to infuse Vancomycin through Midline signed Dr. SEE YOU IN COURT.
It is very simple. As soon as I read your question I said to myself in reflex," No way would I do it!" I am constantly having to educate Mds and Pharmacists on the risk of infusing Vanco via peripheral catheters. It is battery acid!
I recently lost this battle when I refused to give vanco via a peripheral cath on a pt that was ordered for 3-6 weeks. I knew this pt had very poor venous access and requested she get a picc line placed with tip in the CAJ at the local hospital under fluroscope. The pt ended up with a midline placed instead as they found out how bad her veins were, lots of stenosis. She came by to see me 4 days later and I found out about the midline. I looked at her arm and asked how it was feeling? She said,"The line is working great, but I have a little tenderness in my arm." I looked closer, the pain was in the axilla. I immediately called the MD and requested an ultrasound, suspecting a DVT. Sure enough it was and she was admitted for anticoagulation. She went on the throw multiple PE's. She is still in and out of the hosp throwing mult clots to the lung!!!! Gotta trust your gut!!!
I'm the Director of Vascular Access at my hospital, and for about 3 years I've been wondering why we put diluted vanco peripherally, as I'm not aware of any support for the practice. Our pharmacy says that our provider has approved a minimum dilution of 5mg per ml. Given my title, one would think that my proclivity to administer through a central line of some type would carry some weight. Yet one would be wrong.
Jack LeDonne, MD
President, Association for Vascular Access
Director of Vascular Access
Greater Baltimore Medical Center
Jack, I am not sure what you mean by "our provider" but vancomycin was first introduced in the late 1950's with that same concentration of 5 mg per mL and it remained that same level for the past 60+ years. As you well know, we were not using CVADs back then and everything was given through a peripheral catheter or steel needle. No vancomycin manufacturer is motivated to do the required studies of a higher concentration or for PIV vs CVAD infusion as this would be extensive studies required by the FDA. So it is left to infusion professionals to assess published outcomes and facility outcomes to convince the decision makers about the preference for CVADs due to the acidic pH and vesicant nature of vancomycin. Here is the most recent study that I know about:
1. Roszell S, Jones C. Intravenous administration issues: a comparison of intravenous insertions and complications in vancomycin versus other antibiotics. J Infus Nurs. Mar-Apr 2010;33(2):112-118.
Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Our administration explained that the INS standards showing a level V (five) for strength of body of evidence is not strong enough evidence-based research to support the hospital administrator telling the doctors they cannot order midline catheters for repeated vancomycin administration. They explained that it was similar to when a physician uses a medication in an off-label use (a way which is not initially intended). They also described that some physicians disagree with the clinical practice guidelines set forth by their own organizations and do not follow them feeling they are out of date or just plain wrong. So naturally the Infusion Nurses Society standards are not held with as a high a regard by physicians or administrators as nurses would like. This is the explanation given.
It is your physicians judgement to use a medication in an off-label use. But when it come to vascular access, another specialty is involved, which is vascular access nurse. We are a specialty that have our standard of practise. We should not be ordered to do anything violating our guidelines. So many of us on this forum had expressed our concern of using midline for vanco since we all know what can happen if we use this "off-label use" to give vanco. The use of midline says PH has to be between 5-9. It means do not use for medication out of this range. You can ask your administrator would a doctor use a medication for the purpose that is marked "not to use" as an off-label use? I believe in this case, you have all the right to say no and should not be risking your job stability because of it.
On top of everything, what is the reason not to have a PICC line placed? Just because they don't like to deal with a central venous access is not a good enough reason to violate our standard of practice.
I think there needs to be some clarification on this message about off-label use. To give vancomycin through a midline or peripheral catheter is not considered to be off-label. The label is defined by the FDA and includes the directions for use for a device or drug, all promotional material, and even what is spoken by the manufacturers employees. To be an off-label use, one must use the drug or device in a manner not included in those instructions. The label for Vancomycin does not state which type of catheter is required for infusion. This drug was introduced in the 1950's, long before CVADs were in use at all. There are no instructions or directions about the location of vein or type of catheter for infusion of this drug. So therefore, infusion through a peripheral or midline catheter is not off-label.
With clinical experience, we now know that the acidic pH (it will always be less than 4) and the vesicant nature is safer for infusion through a CVAD instead of a peripheral or midline catheter. The ranking for this statement about pH, osmolarities, and vesicants in the 2011 INS standard of practice is a IV, not V. So someone is not reading this reference correctly. The study that I posted in another reply to this thread was a newer reference about Vancomycin and the clinical outcomes with its peripheral infusion. Clinical practice will always evolve as we gain more knowledge through research and outcomes.
The original message led me to think that these orders were for long term infusion of vancomycin. In those cases a PICC or other CVAD is definitely indicated and I would refuse to place a midline in those patients requiring long term vancomycin. On the other hand, if the vanco is prescribed for a pre-op and a couple of post-op doses or you are waiting for culture results to see if this will be needed on a long term basis, then you may be infusing vancomycin through a peripheral catheter. This could easily happen when there is no other indication for a CVAD and your don't know yet how long the therapy will be needed. The risk of a CVAD is greater than the risk of a few doses peripherally in those situations - again this is a risk vs benefit assessment. In those cases where peripheral infusion is indicated for a couple of says, I would only use a 24 g in a large forearm vein, never use a vein in the hand, wrist or AC, always use a catheter stabilization device and closely follow all infusion requirements for dilution and length of infusion. Those factors will reduce, but not eliminate the risk until a more appropriate decision about the needed therapy and correct VAD can be made. But I would never, under any circumstances place a midline for long term vanconycin, regardless of who is prescribing it or what administration has stated. The nurse inserting it will be named in the lawsuit, not the doctor or the administrator. Plus nurses must act as patient advocates and refuse to do anything that is unsafe. Long term vancomycin through a peripheral or midline catheter is an unsafe practice. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Well put Lynn....we have been giving Vanco forever through peripheral lines. However, peripheral lines are removed in 72-96 hours so therefore, short term Vanco , a few doses should be fine. But, even with that, I have seen localized phlebitis occur. So, I think we all agree Vanco given beyond 3-5 days should be given through a central line.
Jack Diemer, RN BSN
ps..Lynn did I hear you were recently in Europe on a fact finding mission to see what European nurses are up to?
No, no European trip. Must be a wild rumor. I will be in Amsterdam at WoCoVA in late June though. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I am sorry but the mindset of "evidence based practice" is really shameful here. For a stronger recommendation we would take a known acidic, vesicant drug and purposefully try to harm patients in blind trials? Can you show me evidence based studies why we should not put PICCs in arteries? Of course not! As I am fairly confident that I taught your team MST I will say this. All the ingredients for a whopper lawsuit are in place. A manager who does not place lines(therefore putting herself out of harms way if litigation occurs!) telling you you should, an administration that is ignoring standards of practice because they are not patient centered but physician intimidated and you who now in a public forum acknowledges that Vanco through a midline is a bad idea. We are only missing the thrombotic injury big enough to sue over. The team at Winchester needs to do the right thing!
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness
Just a question, INS Standards of Practice states " Therapies not appropriate for midline catheters include continuous vesicant therapy" . What is the difference between continuous and intermittent? So if the vesicant is intermittent it is OK? Why doesn't the standards say all vesicant therapy?
Teresa Kamps RN, CRNI, VA-BC
Clinical Operations Manager
Access Scientific Inc
Continuous vs intermittent for a midline catheter is an issue because with continuous infusion, the nurse will leave the patient while the infusion is running. For intermittent injection, the nurse will remain with the patient while the drug is pushed, checking for a blood return and all patient complaints during the injection. This language could be improved because there are times when an intermittent vesicant medication will be infusing and the nurse is not present. Vancomycin is one of those times when infusion will be over 1 hour and the nurse will not remain with the patient. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you for the clarification.
Teresa Kamps RN, CRNI, VA-BC
Clinical Operations Manager
Access Scientific Inc
I faced a similar situation and called the State Board of Nursing. This is what I was told: "You must do the right thing, you may lose your job but with the other option you may lose your license. You need your license to have a job. Your choice." Jobs are not plentiful in my area either so it took some courage.
I have noticed a disturbing trend which is the hospitals are "Diluting" vancomycin and running the infusion for longer periods of time claiming this will increase pH and therefore Ok to give thru midline. I believe dilution will change the osmo but the pH will remain the same. I need evidence to support this. Pharmacists also claim dilution will change Ph which is very fruating because they should know better. Does anyone have any written evidence/studies i can reference to support the case that diluting vancomycin does not change the pH?
Danny Vasquez, RN, MSN, CRNI
Legal Nurse Consultant
www.amicuslegalnurseconsulting.com
www.ctins.org/Marc%20Stranz%20Understanding%20pH%20and%20Osmolarity%20INS%202008.pdf
Phlebitis in vivo
•
Animal data isolates traumatic effect of pH and osmolality
−
No studies of slowing infusions to reduce phlebitis
−
With peripheral parenteral nutrition, pH and titratable acidity cause phlebitis
−
The higher the titratable acidity, the greater the proximal and distal phlebitic changes
www.ctins.org/Marc%20Stranz%202005%20Fall%20INS%20Handout.pdf
Modifying pH and osmolarity
Osmolarity is not the primary cause of infusion phlebitis. The osmolarity of most infusions other than parenteral nutrition is less than 400 mOsm/kg and few are above 500 mOsm/kg (see Chart). Products can be compounded in diluents to reduce osmolarity, such as sterile water or ½NS. Ready-to-Use doses have been created to be isotonic when possible. Frozen antibiotics use sterile water or dextrose to create an isotonic pH because dextrose has a lower tonicity than normal saline. Furthermore, the dextrose is titrated to the desired osmolarity instead of using D5W (range of 0.6% to 5%). Ready-to-Use drugs are popular because they save labor and reduce waste.
The pH profile of a drug will determine the pH at which the product is formulated. This usually correlates to the pH of maximum stability, but can be a pH to enhance solubility. Significant variance from the ideal pH can lead to drug decomposition or precipitation. Ready-to-Use products are not neutral because optimum drug stability is usually found at the extremes of pH. Drug manufacturers all stated that their products are as close to physiologic norms as the pharmaceutical parameters permit.
Dextrose solutions are acidic because dextrose decomposition increases as the pH rises. Saline solutions are stable at a neutral pH, but are made acidic to enhance drug additive stability. The degree of saline acidity differs by country, with the US establishing a pH of 5 and Japan setting it at 6.
Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.
Diluting an acidic solution with a neutral pH solution, will raise the pH closer to 7. Am I missing something here?
Diluting an acidic solution with a neutral pH solution, will raise the pH closer to 7. Am I missing something here?
Quote":
Are infusion volumes greater than 250ml required for larger doses?? [IJPC - background info]
Osmolarity: 2 grams of vancomycin added to 100 mL of 0.9% sodium chloride injection has a calculated osmolarity of 348 mOsm/L, however the actual osmolarity using an osmometer is much lower (~ 230) or HYPOTONIC. Further, vancomycin is very acidic - pH of ~ 3.4 (admixture). A 20
to 40 fold dilution of the reconstituted vial (1 gram/20 ml) will result in a negligible change in the pH ( ~+ 0.3). The primary purpose of the dilution is to facilitate a slower administration rate and to reduce the amount of drug present per unit of volume. For
additional guidance, please review data available through the International Journal of Pharmaceutical Compounding: Direct quote: "The best method of addressing the pH of vancomycin is that of infusing the drug through a catheter with a tip location in a vessel that will allow for adequate
hemodilution. If ideal venous access is not possible, routine rotation of the site and informing the patient of the signs and symptoms of phlebitis are important in preventing morbidity." Kastango, ES, Hadaway, L. New Perspectives on Vancomycin Use in Homecare,. Part 1. Int J Pharm Compd. 2001; 5: 465-469."
http://globalrph.com/vancomycin_dilution.htm
You can also read a thorough explanation of pH and osmolality in this reference written by a pharmacists.
1. Stranz M. Adjusting pH and osmolarity levels to fit standards an practices. Journal of Vascular Access Devices. 2002;7(3):12-18.
Sorry, I thought I could easily find an electronic copy but I can't. Maybe someone else has it to post. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you Lynn-
I had those 2 resources already but hoping to find more recent data since they are from 2001, 2002. The stronger and more recent data I can present will justify this pateint care safety issue which has sprung up with the new "Midline" devices now on the market.
There is only one publication about these new midline power injectable catheters and that is reporting on experience with 1 brand. The chemistry issues will not change over time - what was true 10-12 years ago is still appropriate today when it comes to pH alterations. I don't think you will find anything newer than these. Wish that was not the case, but studies on devices llike these are not done until they have been introduced to the market and in use for a while. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
As a patient advocate, any time I hear of Vanco (or other drug that falls outside the 5-9 pH level) I recommend a PICC, and always include "for patient safety issues". I have only ever had one DON tell me that she did not care about the patient safety issues. I told her about the INS standards, and she said that she did not care about some rinky-dink organization, that those are only recommendations, not fact. She insisted that I place the Midline because that's what the doctor ordered. I told her that if I did, then I would chart that this is against professional standards, and I would also include her comments about not caring about the standards or patient safety issues. By the time I got to the facility to place the Midline, the order had been changed to a PICC.